Risk Management



Tweeting During Eye Surgery?

The idea of communicating with the “outside world” directly from the operating room is not new. Ophthalmologists, surgery centers and hospitals have allowed messaging in the form of texts, phone calls, and emails from the ophthalmic operating room for many years. Since the 1990′s some ophthalmologists have even performed ophthalmic surgeries such as LASIK in conjunction with newscasts or other events. As social networking becomes a new way for many of us to communicate with friends and colleagues, it is only natural that some physicians will adapt and exploit these tools for either marketing or educational reasons (or both).

Sometimes, during medical conferences or training events a surgery will be documented as a timeline or photographed or videotaped in order to assist physicians who are learning about new techniques. In private practice or hospital settings, physicians may want to educate the general public about new medical options that are available.

(Especially if the surgery is without complication) this type of event can be a marketing and educational bonanza. However, there are also serious concerns regarding the increased exposure to liability for the ophthalmologist. Most physicians take their hippocratic oath seriously and place patient safety ahead of all other concerns when performing medical procedures. However, perception and reality sometimes diverge when the general public is exposed to unfamiliar medical procedures or operating room protocol.

Those who proceed with using any form of communicative device during the performance of surgical procedures, should do so very cautiously to avoid conducting events that might be considered by patients or the general public to be “gimmicks” or “marketing ploys” as opposed to educational. If patients or colleagues learn about new or less “well-known” ophthalmic procedures, then this could represent a win-win for all of the ophthalmic health care participants. If the event is viewed as being self-serving or exploitative by either the physician or the medical facility, it may represent a major setback for the ophthalmic practice.

Ten questions to ask before proceeding with Tweeting, Facebooking, Podcasting, or YouTubing from the operating room:

  1. Have you considered HIPAA? Ophthalmologists, like other physicians are held to strict privacy regulations under HIPAA and HITECH acts. Even if you have a patient sign a HIPAA compliance form, it will not absolve you from acting in accordance with these laws. The ease with which tweets can be posted raise serious issues of medical privacy and professional ethics.
  2. Are you doing it solely for marketing purposes?Ohio State University Medical Center, which has published several valuable resources on social media use in healthcare settings, suggests physicians pursue events for “the right reasons”. While education about a medical procedure that isn’t particularly well-known by the general patient population may present a valid and ethical reason to proceed, there is a fine line between education and marketing. Any time you’re using social media, it should be used to create educational value for someone (besides yourself).
  3. Have you obtained sufficient and appropriate patient consent? You should have a vigorous and well documented consent process for any ophthalmic procedure, however this type of event most likely also requires additionalconsent for HIPAA/HITECH as well as a customized release for any legal issues surrounding publicity of the event. You should always consult an attorney that specializes in such contracts.
  4. Do you have a plan in place for deviations or emergencies?Live updates (and certainly videotaping) present  a serious need for planning what you and your staff will do if there are complications. In malpractice litigation, any discrepancies in the recording  or documentation of an event, particularly ones that are viewed as being deliberate, could be highlighted during a trial as “evidence” of negligence or wrongdoing. Know going in exactly what will happen to a video, text or twitter stream if there is a medical complication and make sure staff understands how to respond.
  5. Who is your audience?There are major differences in how a procedure is viewed by a physician vs. an “average” viewer or potential patient. For instance, the average viewer may be unfamiliar with reasonable actions taken or comments made during the course of surgery and assume physician error or fault even when the physician is simply responding to known surgical complications. Is the average viewer going to understand SOC  – standard of care – or be concerned by what they see if the event does not proceed as originally planned (or promoted)? If broadcast of an event is abruptly stopped without sufficient explanation it may cause a damaging or lasting negative impact on your practice.
  6. How will related duties be delegated?As is the case clinically, you should have a team approach to educational or promotional events. This is not the time to practice multitasking. One staff member, not involved in any clinical duties, should be designated to send out tweets, and a separate person (again not tasked with any other duties) should monitor the twitter stream for questions and comments. If video or audio is required a separate person should be assigned to each additional duty. The safety and well-being of the patient takes precedence in the operating room.
  7. Are you paying attention to perception?It is important to have a disinterested third party review parts of (or all of) your plans before implementation. You do not want to make the mistake of being “tone deaf” to what the general public may think about your event. If a claim of malpractice is filed at some point in the future, a jury will not necessarily include persons familiar with your medical field, so be proactive and sensitive to perception and avoid insular discussions limited to internal medical staff only.
  8. Have you considered a focus group?Some persons may embrace new technologies simply as (the latest) tool that allows for caring and theraputic updates for family members worried about their loved ones during surgery; while others may view the idea that some (any) health care team members not focused 100% directly on the patient’s procedure is innapropriate in the operating room. Be sensitive to varied opinion. While you cannot control the way every person perceives any event, you should try to expand initial description of your plans to a diverse group so that you can anticipate different points of view and design promotional materials and statements around them.
  9. Are you following ethical recommendations?  Ophthalmic societies and medical associations may provide guidance regarding appropriate patient (or public) safety considerations. While clinical and consent issues may be appropriately covered during the pre-operative consultation with the physician, there may be additional required ethical responsibilities for the physician regarding the publicizing of the event.
  10. Have you educated third parties about possible complications? Any comprehensive consent discussion will attempt to include a patient’s family members in explanation of risks, benefits and alternatives of any significant medical procedure. In addition, if members of the media, the patient’s friends or loved ones, or the general public will be monitoring the event, at the very least basic appropriate information about the inherent risks (and possibility of complications) should be presented prior to the event to minimize concerns that may arise during the procedure if complications do arise.
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